Today’s Research – Earlier tracheostomies improve outcomes

Researchers at Penn State College of Medicine are actively working in Hershey, with colleagues at Penn State, University Park and other Penn State campuses, and with colleagues at various institutions across the country to conduct groundbreaking research. Their discoveries continue to contribute to the advancement of health care on all levels.

A tracheotomy performed within the first seven days after a severe head injury results in better overall patient outcomes, according to a team of College of Medicine researchers. This is especially true for patients who have a greater chance of surviving when admitted to the hospital. A tracheostomy is an opening created in the front of the neck directly into the trachea to allow unimpeded breathing (a tracheotomy is the act of making that opening).

“The CDC estimates that more than 200,000 individuals are hospitalized annually for traumatic brain injury,” said Kevin M. Cockroft, M.D., ’02, associate professor of neurosurgery at the College of Medicine. “Severely head-injured patients, particularly those with additional injuries, often require tracheostomy at some point during their hospital stay.”

Previous studies have shown mixed results. “Traditionally, tracheostomy, or ‘trach,’ has been recommended to prevent airway complications,” Cockroft said. “Early trach has been advocated as a means to improve outcome, with various studies suggesting that it may decrease the incidence of pneumonia, reduce intensive care unit days, and shorten overall length of stay. Some evidence also exists to suggest that early trach does not improve outcomes. As a result, the timing of trach in these critically ill patients remains controversial.” These results indicate a complex relationship between tracheotomy timing and outcome but suggest that a strategy of early tracheotomy, particularly when performed on patients with a reasonable chance of survival, results in a better overall clinical outcome than when the tracheotomy is performed in a delayed manner. Researchers reported their results in the journal Neurocritical Care.